Firstname(s): / E-Mailaddress:
Lastname: / Dateofbirth:
Formername(s): / NINumber:
Homeaddress:
Postcode: / Detailsofpersontocontactinanemergency
NameAddress:
Postcode:
HomeTelephone: / EmergencyTelephone:
Jobtitle: / OFFICE
Applicationno:USEONLY
DoyoucurrentlyworkforSandwell
MetropolitanBoroughCouncil?YesNo
AreyouontheAtRiskRegisterfor
SandwellCouncil,SandwellLeisureTrust
orSandwellHomes?YesNo
Referenceno:
Closingdate:
CONFIDENTIAL
SchoolNon-TeachingApplicationForm
PleasenotethatCV’scannotbeaccepted
PleasecompleteALLSectionsofthisformasappropriate,
andforeaseofphotocopying,completeinTypeorBlackInk.
Pleasenotesections1,23ofthisapplicationformwillberemovedpriortoshortlisting.
Returnthecompletedformto:
IfyouareapplyingforaSocialCarepost,areyou
registeredwiththeGeneralSocialCareCouncil(GSCC)? Yes No
IfYES,whatisyourGSCCRegistrationno:
1
Section2:EqualOpportunities
Aspartofourequalopportunitiespolicywerequestthatyoucompletethefollowing
information.Thisinformationisusedformonitoringpurposesonly.Allinformationwill
betreatedasconfidentialandwillnotbeusedwhenshortlistingordecidingonwhether
anapplicantissuccessfulorunsuccessfulinobtainingemployment.Theinformation
youprovidewillhelpustoensurethatourrecruitmentproceduresarefairbyallowing
ustoidentifyandeliminatepotentialareasofdiscrimination.
EthnicOrigin
Prefernottosay
AsianorAsianBritish-Bangladeshi
AsianorAsianBritish-Indian
AsianorAsianBritish-Pakistani
BlackorBlackBritish-Caribbean
MixedEthnic-WhiteAsian
MixedEthnic-WhiteBlackCaribbean
OtherEthnicGroup-Arab
White-Irish
White-Welsh/English/Scottish/N.Ireland
OtherEthnicGroup/comments
Religion/Belief
Buddhist
Hindu
Muslim
Other
Anyotherethnicgroup(notlisted)
AsianorAsianBritish-Chinese
AsianorAsianBritish-Other
BlackorBlackBritish-African
BlackorBlackBritish-Other
MixedEthnic-WhiteBlackAfrican
MixedEthnicGroup-Other
White-GypsyorIrishTraveller
White-Other
Christian
Jewish
None
Prefernottosay
Sikh
Disability
TheEqualityAct(2010)definesadisabledpersonassomeonewithaphysicalormental
impairmentwhichhasasubstantialandlong-termadverseeffectonhis/herabilitytocarryout
normalday-to-dayactivities.
Doyouconsideryourselftohavesuchadisability?
YesNo
DisabilityCategory
HearingImpairment
LearningDisability
Learningdifficulties
MentalHealthCondition
continuedonPage3
2
Neurologicalcondition
Physicalco-ordinationdifficulties
Reducedphysicalcapacity
Speechimpairment
Prefernottosay
Visualimpairment(notcorrectby
Mobilityimpairment
Other
Physicalimpairment
Sensoryimpairment
None
Long-standingillnessorhealthcondition
spectaclesorcontactlenses)
Pleaseidentifyanyspecialrequirements,adjustmentsorequipmentwhichmayassistyou
(a)intherecruitmentprocess______
(b)toenableyoutocarryoutthejob______
Gender
Female
Prefernottosay
AgeRange
16-17
25-29
40-49
60-64
SexualOrientation
Bisexual
Heterosexual/straight
Male
18-24
30-39
50-59
65+
Gayman
Prefernottosay
Lesbian/Gaywoman
Tothebestofyourknowledge,areyourelatedtoanyCouncilMemberand/ortoany
employeeofSandwellMetropolitanBoroughCouncil?Ifso,pleaseexplain:______
______
DoyouhavealegalrighttoliveandworkintheUK? Yes No
Ideclarethat,tothebestofmyknowledgeandbelief,theinformationIhaveprovidedistrue.
Iunderstandthatanyfalseinformationorfailuretodiscloseanycriminalconvictionswill
result,intheeventofemployment,inadisciplinaryinvestigation,andmayresultindismissal.
SignedDate
PLEASENOTESECTIONS12OFTHISAPPLICATIONFORMWILLBEREMOVEDPRIORTOSHORTLISTING
3
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4
Date / College/University(NameAddress) / ExaminationResults
(Subject,LevelandGrade)
From
Mth/Yr / To
Mth/Yr
Date / College/University/TrainingProvider
(NameAddress) / CourseTitle/Results
From
Mth/Yr / To
Mth/Yr
Date / School/College/University
(NameAddress) / ExaminationResults
(Subject,LevelandGrade)
From
Mth/Yr / To
Mth/Yr
Jobtitle:
Applicationno:
OFFICE
USEONLY
Referenceno:
Section3:Education,TrainingQualifications
Otherqualifications,membershipofprofessionalbodies
5
Currentjob/posttitle:Nameaddressofemployer:
Postcode:
Salary/wage:Grade/scale:
Howlonghaveyouworked/
didyouworkthere? / From:To:
Pleasestatenumberofyears:
Doyoustillworkthere: / Yes / No
IfYES,periodofnoticerequired?
IfNO,reasonforleaving
Brieflydescribeyourduties:
Section4:Experience
Pleasecompletethefollowing,startingwithyourcurrentemploymentandincludeall
employment.Anyemploymentwithtemporaryworkagenciesmustshowtheagencyas
theemployeraswellasthebusinesswheretheworkwascarriedout.Pleasealso
includeanybreaksinemploymenthistorytogetherwiththereasonforthebreak.Please
completethefollowingaccuratelyandincludeallexperiencesincetheageof16,or
6
Date / Employersnameaddressoryouractivityifyouare/were
notemployed / Positionheld / Reasonfor
leaving/breakin
employment
From
Mth/Yr / To
Mth/Yr
PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerof
thepage.
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Section5:SupportingInformation
Pleaseusethispagetooutlineanyotherinformationthatmayhelpyourapplication.
Continueonaseparatepageifnecessaryandattachitwithonestapleinthetopleft-
handcorner.
PleasecontinueonaseparatesheetifnecessaryandattachitwithONEstapleinthetopleft-handcornerof
thepage.
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Name: / Name:Address:
Postcode: / Address:
Postcode:
Telephoneno: / Telephoneno:
E-Mailaddress: / E-Mailaddress:
Occupation: / Occupation:
Date / TypeofOffence / Sentence/FineImposed / Comments
Section6:Convictions
RehabilitationofOffendersAct1974(exceptions)Order1975
Ifyouhavebeenconvictedofanyoffence(s),orifthereareanyproceedingspending
againstyou,pleasegivedetails.
IfthePersonnelSpecificationadvisesyouthataCriminalRecordsBureaucheckwillbe
required,thepostyouareapplyingforiscoveredbytheRehabilitationofOffendersAct
1974(exceptions)Order1975.Thismeansthatyoumustdeclareallconvictions,including
cautions,reprimandsandformalwarningsforanyoffence(s)whichforotherpurposesare
‘spent’undertheprovisionsoftheAct.
Failuretodiscloseanypreviousconvictions(includingcautions)reprimandsandformal
warningscouldresultindismissalshoulditbesubsequentlydiscovered.Anyinformationgiven,
eitherwhenreturningthisapplicationformorataninterviewwillbeentirelyconfidentialand
willbeconsideredonlyinrelationtothisapplication.
Section 7: References
-
IfyouhavepreviouslybeenemployedbySandwellCouncil,theunitinwhichyouworkedwill
beaskedtoconfirmdetailsofyouremployment,includingthereasonforyourleaving.
Maywecontactyourcurrentemployerat
thisstagewithoutfurtherreferencetoyou?YesNo
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JobCentre / Fish4JobsWebsiteLocalNewspaper / RegionalWebsitewmjobs.co.uk
NationalNewspaper / FromFriendorColleague
SpecialisedPublication / Sandwell’sJobsOpportunityBulletin
Sandwell’sJobsWebsite / Other,pleasespecify
Monster’sJobsWebsite
Section8:DataProtectionAct
TheinformationyouareprovidingwillbeusedbySandwellMetropolitanBoroughCouncilin
connectionwithyourapplicationandforassessingyoursuitabilityforthepostadvertised.The
informationwillbesharedonlyincompliancewiththelawandforthepurposeofmonitoring
theCouncil’spracticestoensureequalityofopportunity.
IfIamappointedtoworkwithSandwellMBC,Igivemypermissionformynameandcontact
detailstobeprovidedtotherecognisedTradeUnionsinSandwell(pleasetickasapplicable).
YesNo
Section9:Howdidyoufindoutaboutthisvacancy?
Pleaseindicatewhereyoufirstsawinformationaboutthisvacancy.
N.B.Canvassingforthisappointmentwilldisqualifyyourapplication.
Pleasecheckthatallsectionsofthisformhavebeencompletedandandifreturningby
post,thatyouhavesignedthedeclarationonthebottomonpage3.Ifyoue-mailthis
formyouwillbeaskedtosigntheformifyouareinterviewed.
P.18/SchoolsRev.04.11
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